Document Detail

Autonomic control in patients experiencing atrial fibrillation after cardiac surgery.
MedLine Citation:
PMID:  17241319     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Atrial fibrillation (AF) occurs in 20-40% of patients after open heart surgery and leads to an increased morbidity and prolonged hospital stay. Earlier studies have demonstrated that depressed baroreflex function predicts mortality and major arrhythmic events in patients surviving myocardial infarction. Cardiac surgery per se leads to decreased baroreflex sensitivity (BRS) and heart rate variability (HRV). Hence, the present study was aimed at analyzing the impact of the cardiovascular autonomous system on the development of postsurgical AF. METHODS AND RESULTS: The study covered 51 patients who consecutively underwent aortic valve replacement, coronary artery bypass surgery, or combined procedures. Noninvasive blood pressure and ECG were recorded the day before and 24 hour after surgery. BRS, linear as well as nonlinear HRV parameters were calculated using established methods. Eighteen patients developed AF during the first postoperative week, while 33 remained in sinus rhythm (SR) throughout the observation period. Patients with postoperative (PostOp) AF exhibited a significantly reduced preoperative (PreOp) BRS in terms of bradycardic and tachycardic regulation (average delayed slope [ms/mmHg]: SR: PreOp: 9.83 +/- 3.26, PostOp: 6.02 +/- 2.29, Pre-Post: P < 0.001; AF: PreOp: 7.59 +/- 1.99, PostOp: 6.39 +/- 3.67, Pre-Post: P < 0.044; AF vs SR: PreOp: P < 0.01, PostOp: ns). In both groups, surgery caused a decrease of BRS and HRV. Analysis of nonlinear dynamics revealed a tendency toward decreased system complexity caused by the operation; this trend was significant in patients remaining in sinus rhythm. CONCLUSIONS: Patients experiencing postoperative AF obviously suffer from an impaired BRS before surgery already. These findings may be used to guide prophylactic antiarrhythmic therapy.
Robert Bauernschmitt; Hagen Malberg; Niels Wessel; Gernot Brockmann; Stephen M Wildhirt; Burkhard Kopp; Jürgen Kurths; Georg Bretthauer; Rüdiger Lange
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  30     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-23     Completed Date:  2007-07-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  77-84     Citation Subset:  IM    
Department of Cardiovascular Surgery, German Heart Center, Munich, Germany.
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MeSH Terms
Atrial Fibrillation / etiology*
Autonomic Nervous System / physiopathology*
Cardiac Surgical Procedures / adverse effects*
Heart Rate*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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